1. Technical Field
The disclosure herein relates to surgical instrumentation for everting body tissue, particularly blood vessels, in minimally invasive or open surgery, and methods for using same.
2. Background of the Art
In surgical procedures for edge to edge joining of body tissue, the edges of the tissue are often everted and held in close approximation in order for the tissue to be sutured. For example, to join the ends of tubular structures such as blood vessels, the ends of the blood vessels can be everted to facilitate joining by suture threads and more recently by clips. Other methods of joining such as side-to-side and end-to-side can also be used for joining tubular structures. A preferable way to join body tissue is by the application of non-tissue penetrating clips, which cause less trauma to the body tissue than suturing or penetrating clips. Such clips require proper eversion of the body tissue.
Everting instruments are known in the art. For example, U.S. Pat. No. 5,300,065 to Anderson discloses a method and apparatus for holding and sealing a longitudinally extending edge of tissue. The tissue is everted and held in position by a clamping member.
U.S. Pat. No. 5,527,324 to Krantz et al. discloses a surgical stent for use in supporting the walls of a tubular organ during anastomosis. The stent includes a circumferential ridge adapted to evert the edges of the tubular organ to facilitate suturing.
U.S. Pat. No. 4,622,970 to Wozniak discloses a vascular everting instrument having an annular member with an iris-diaphragm mechanism to flare the leading edge of the blood vessel to facilitate anastomosis.
U.S. Pat. No. 5,486,187 to Schenck discloses a method and device for anastomosis of blood vessels. The device includes a ring-like member through which the end of a first vessel is extended and everted back over. A second vessel end is drawn over the everted first vessel end to place the lumen of these vessels in apposition. Fasteners are then applied to clinch the vessels.
U.S. Pat. No. 5,520,704 to Castro et al. and U.S. Pat. No. 4,950,281 to Kirsch et al. disclose everting forceps which include first and second outer resilient legs interconnected at one end, and a third leg intermediate the pair of outer legs. The outer legs terminate at tips provided with arcuate jaws. The intermediate leg terminates in a spherical tip.
What is needed is improved instrumentation for everting vessels.
What is also needed is improved instrumentation which can be used in minimally invasive surgical procedures such as laparoscopic or endoscopic procedures. Typically, in minimally invasive procedures a cannula is placed in an opening in a wall of body tissue and the surgical instrumentation is sent through the cannula into the patient's body wherein the operation is performed. One or more additional cannulas provide access for fiberoptic viewing instruments and other surgical instrumentation. The operating end portion of the instruments is generally long and narrow to be able to fit through the cannula and reach the inside of the body cavity where the operation is being performed. In procedures such as abdominal surgery wherein the operating site is insufflated, it is generally necessary to have a seal both within the equipment and between the equipment and cannula to prevent the entry or egress of gases or other fluids into or out from the patient's body. An advantage of minimally invasive surgery is that there is much less trauma to the patient. Both operating time and recovery time are significantly shortened.